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how deplorably wretched he feels. Headache, nausea, loss of appetite, the stoppage of the flow of urine, and disinclination to any active exertion follow, perhaps for days to come. In other persons more susceptible, the symptoms are even more violent, whether opium or morphia be given in the way of hypodermic injection, or administered in the way of powder, pill or mixture. It produces giddiness, an itching sensation about the nose, face and other parts of the body; stupor intervenes and perfect calmness. There may be warmth, sweat, redness and heat of the skin; but soon the stupor increases, slowness of breathing follows, the circulation becomes depressed; the pulse becomes more and more feeble; then are cold clammy sweat, general relaxations of the muscles, involuntary discharges from the bowels and urinary organs, contracted pupils; and death finally ensues.
I had supposed that that time had passed away when physicians would boast as I used to hear them long years ago, saying "Give me opium and morphia in one of my vestpockets, calomel, blue mass and the lancet in the other, and I am ready to combat any disease." That class of men, thank God, are very few now-a-days. While, however, many great errors heretofore held to in the practice of medicine have passed into oblivion, let me caution you not to fall in line and follow the foolish fashion so much practiced these later days by the carrying of a hypodermic syringe in your vest-pocket, making it a hobby, using morphia injection under the skin for any and every ailment. For this practice they are responsible for that morphinism which physicians meet with in their everyday practice. Patients finding oftentimes imaginary or temporary relief, again and again have the same remedy prescribed for them. Soon they will no longer consult a physician about its use, especially when they have been told how much to take or use. They will procure a hypodermic syringe and inject it themselves, on account of its exhilarating influence over them, making them talkative, "using their tongue as though it were loose at both ends;" their eyes sparkingly brilliant, a constant flow of thought, displaying oftentimes a wonderful degree of intelligence; their steps and bodily move
ments like that of a youth, full of mirth and play. But how wretched and how changed when its effect is worn off; how sick and miserable the feelings! They evidently feel like the rooster that we sometimes see displayed at the head of a column in a newspaper over the defeat of some candidate for office on the day after election.
These miserable creatures, for such they are, have become so enslaved, even worse than by the shackles of slavery, that to live without it is death, and to continue its use is death. The once beautiful form, and well-balanced organism, all parts of their system in perfect symmetry and proportion, the bones, the flesh, the nerves, the blood-vessels, everything clearly, distinct and well defined-all the faculties of the mind welltrained and cultivated in the highest degree, how is it now? What has led to all this?
In view of all this, can we, as physicians, stand by and give no word of warning? Can we, as men, in whose charge is given the care of the sick, entrusted with the health and life of our fellow-men, we, who should further the best interests of society, can we, as physicians, I ask, be guilty of encouraging and sanctioning, and holding out the instrument which we know will bring about woe, misery and death? Physicians are in duty bound to know all the effects of remedial agents employed. They should never forget to enquire what effect medicines will have upon their patients in the way of combatting disease; whether it may not become the originator of morbid action, instead of controlling it. A correct knowledge of the drugs or medicines employed is highly important, as is also the knowledge how and when to use them. It is necessary to study and consider well the condition of the patient, never arriving at hasty conclusions without first knowing more about the different temperaments. In the administration of narcotics, more particularly opium or morphia, we find that when even given in minute doses we are apt to meet with disappointment, and the effect it has upon our patients is not always as we wish to find it.
Here I may be allowed to mention a case. A gentlemen whom I attended some eighteen months ago for a severe at
tack of pneumonia. The patient was about fifty-six years of age, hearty, robust, of good habits, excellent physique, usually good health, and one of that class of persons we often times find most difficult to manage when sick. He suffered much pain; there were incessant cough and expectoration, and considerable fever. He was restless and could not sleep. To procure this the remedies used, tincture of Gelsemium, belladonna, Veratrum viride, Hyoscyamus, and the bromides, proved unavailing and about the night of the fifth day, from the time he became so very sick I gave two-fiftieths of a grain of sulphate of morphia "in granules," expecting that it would afford him some sleep. But on visiting him at an early hour the next morning, I found him stupefied, with small and feeble pulse, cold, clammy sweat, disinclination to take notice of anything, lying in a semi-unconscious state, which caused me a good deal of anxiety. I quietly kept my fears from the knowledge of his family and friends, but sought to overcome the difficulty by judicious treatment and the close watching necessary in such cases. In due time he rallied, and after along, hard-fought contest not only of lung-fever, but also, a very severe attack of erysipelas plegmonodes which followed, he made a good recovery, and is this day enjoying excellent health. I resolved never to give that man any more morphia. The effects are not alike in all cases; some become more wakeful and rest less if not delirious. Others become stupid, languid, and their whole organism becomes morbidly impaired; while again, others are greatly benefitted, procuring that oftentimes so much-needed rest and sleep, relieving pain and quieting distress, and many times making possible a recovery, when otherwise the result might have been fatal. So with the use of the hypodermic syringe. The injecting of morphia under the cuticle is oftentimes of great benefit and may afford quick relief. Yet in a large number of instances it would have been far better had it never been resorted to. Here is where so frequently great mischief is done. The patient finding quick relief, the physician flattering himself that it will be said that he has done most wonderful things, he allows himself to give way to the patient on return of pain. Soon the patient
gets into a habit, not only in the more frequent repetition, but also of increasing to larger doses, and he becomes a slave to its use, thinking that he cannot do without it. Having commenced with the eighth or quarter of a grain occasionally, he will use it now daily, repeating from one to three times a day, and that, too, not only increasing in frequent repetition, but also the largeness of the dose to from two to four, six and eight grains during the course of the day. He becomes careless, stupid, lazy and unfit for any duty. But let him take or use the usual amount of morphia, we notice a great change, and it is truly wonderful how quick he will rally, becoming brilliantly talkative, full of hilarity, and seemingly all goes well. When, however, the effect of the drug is worn off, he again begins to droop like a flower exposed to a hot summer's
Not many months ago I was called to see a lady some one hundred and ten miles from where I reside. She was twentysix years of age, and suffering with gastritis. She had been sick one week, and had previously been attended by a prominent physician of the place. Her stomach had rejected the least particle of food, liquid or medicine of any kind. The symptoms were attended with hiccough and constant pain in the epigastric region. While in this condition sulphate of morphia had been resorted to and applied hypodermically, and under its influence the stomach would seem quieted, and the patient suffer no pain. Her condition was precarious and her recovery was considered very doubtful. In consultation with the physician attending, and learning what the course of treatment had been, I at once objected to the further use of morphia. Assuming the further treatment of the case, by request, I ordered a sponge bath, with diluted alcohol, over the body as far as practicable, and applied mustard-plaster over the region of the stomach to the upper arms and calf of the legs. There had been no action of the bowels for days. I ordered an enema of tepid water and salt, and gave Aqueous Syrup, Rhei et Potassæ, ziijss., fluid extract Sennæ ss., mix. Dose, one teaspoonful every hour. The stomach retained this dose nicely. After three hours had passed I increased the dose
to two teaspoonfuls every two hours, and in about twelve hours it had operated sufficiently. At intervals I had the patient take of small portions of sugared brandy and water, oatmeal gruel, etc. On leaving I prescribed Fl. Ext. Anthemis Nob. flzii., soft water, ziv. Dose two teaspoonfuls every two hours; also ordered that she be often sponged with spirits and water, and directed light diet in small quantities at a time, gradually increasing as the stomach would bear it. Convalesence was rapid. On the sixth day afterward I received a letter written by the invalid, now convalescent, to the effect that she was doing well, and thanked me for her speedy recovery. This case no doubt would have proved fatal if there had been no change of treatment.
A death lately occurred caused by use of morphia applied hypodermically in the city where I reside. In the month of October, 1882, a most estimable lady, the wife of one of our prominent physicians had been out calling upon some of her neighbors early in the afternoon. Returning home she complained of headache, which she was subject to at times, and at such times she had been relieved by the hypodermic use of sulphate of morphia. At this time she requested of her husband to administer the injection. He complied, but with some hesitancy. In about half an hour, her head still aching, she prevailed on him to inject more morphia. He did so, and left her, going to his office a short distance away. In less. than half an hour he was summoned home, as she could not be aroused, but remained in a stupor, and like the flickering light, her life gently went out. At an early hour the next morning she was dead.
It was declared by the doctor that she did not get more than half of one grain, but that the syringe, however, was somewhat out of gauge, and she possibly might have received a little more. Certainly it was a most lamentable blunder and does not furnish a shadow of excuse.
We look upon a poor, miserable wretch, who has given away to debauchery and drink, with disgust and abhorence. Our pity and sympathy oftentimes goes out and we behold the misery which it inflicts upon kindred friends and society.